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Healthy Aging

So You Think You Can't … Take Charge of Your Sex Life?

By Sheryl Kraft

Created: 08/19/2014
Last Updated: 08/19/2014

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The most common myth is that once a woman goes through menopause, she becomes asexual and dried up and no longer interested in sex. Nothing could be further from the truth!
—Gynecologist Dr. Donnica Moore

The benefit older women experience is that once the responsibilities are gone, it's a great time to regain passion for life, love and sex. Older women are having the best sex of their lives—it's all about sexual self-discovery and growth.
—Sex therapist Dr. Shannon Chavez

OK, so here we are: women of a certain age who, by now, are wise enough to know a thing or two about recognizing life's challenges and taking take care of ourselves. I'm pretty confident that I can count on the fact that the majority of us have experienced, discussed, suffered through, put up with, mastered one or more of the following: hot flashes, mood swings, difficult people, challenging circumstances, empty nest, death, divorce, downsizing, weight gain, bloat, illness, pain, health scares, health threats, having "work" done, becoming an in-law, losing a pet, losing your waistline, losing your keys. Feel free to add to the list.

Think about it. There are so many challenges that occur in a short time, usually around the menopausal years.

But there's something that many women never expected, and, if they did, they are not quite sure how to confront it: painful sex. I had the pleasure of interviewing two experts I met one evening at an educational event in New York City on this subject that many women are hesitant to discuss.

If you want to take charge of (and enjoy) your sex life, here are some insights from Donnica Moore, MD, a highly regarded woman's health expert and advocate and president of the Sapphire Women's Health Group with an impressive bio too exhaustive to list here, and Shannon Chavez, PhD, a dynamic and brilliant sexual health expert with a private practice in Beverly Hills, California, specializing in marriage and family therapy.

SK: What are some physical problems women face during and after menopause that affect their sexual drive as well as the actual act of sex?

DM: The most infamous symptoms of menopause are hot flashes and their nighttime counterpart, night sweats. These can be disruptive to a woman's sleep, as well as her libido. But the menopausal symptom most likely to interfere with a woman's sex drive? That's vaginal dryness. The condition is called vulvovaginal atrophy (VVA) …  which results from a lack of estrogen and the resultant thinning in the tissues of the vagina.

SK: What are the implications of VVA?

SC: The vaginal tissues go from plump, lubricated and pain-free to dry, smaller in size and more prone to irritation and infection. When a woman loses vaginal secretion, it takes even more time to lubricate when sexually aroused. She may also experience reduced clitoral sensitivity, less orgasmic intensity or even the loss of ability to orgasm. Intercourse becomes associated with pain—not pleasure. Women describe the sensation from these changes as "sharp, stabbing pain" and irritation in the tissue, both internally and externally.

SK: How long can women expect these problems to last? I'm sure it's different for everyone, after all.

DM: In approximately 80 percent of menopausal women, hot flashes usually resolve within five years. However, VVA only worsens over time—unless it's treated.

SC: Every woman experiences menopause differently; some experience changes gradually, some all at once, and others, not at all. Unfortunately, there's no menopause manual and time clock that can predict what will happen when. We also have to take into account the roles of nutrition, stress, health problems, family history, chronic illness and premenopausal health when considering the duration of menopausal changes.

SK: OK, it's solution time. Vaginal dryness and changes seem inevitable. Are there ways to deal with them or maybe even slow progression?

DM: Lubricants [and vaginal moisturizers] can provide some symptomatic relief (but don't actually treat the underlying problem). There are various forms of estrogen therapy, both systemic, like pills, patches or gels, and in vaginal cream form. And now, there's a new non-estrogen oral therapy to treat moderate to severe painful sex due to menopause, called Osphena [ospemifene tablets].

SC: The main treatment for decades was an estrogen replacement therapy called Premarin [also, Prempro and Premphase], which was marketed to women as a way to "preserve your femininity" and ease everything from hot flashes to anxiety. But once research found that long-term estrogen replacement therapy increased a woman's risk of breast cancer and affected libido (many women reported loss of sex drive and desire), there was a push for more holistic and hormone-free treatments for menopause, like Chinese herbs, acupuncture and bioidentical hormone therapy. Other treatments include DHEA suppositories (inserted in the vagina daily) and an all-organic cream called Sex Butter, which can naturally moisturize, coat and heighten sensation; it reduces pain and works to address vaginal atrophy.

SK: With all the changes—and options—it seems that there's an opportunity for women to take charge or their sex lives and turn things around. But first, we have to relearn the "language of sex" and find the best professionals to talk to.

DM: For many women, menopause may be the first time they've had to discuss sexual problems or symptoms with their partners or physicians. But aside from being unprepared for having these symptoms, many women are unprepared for the conversation. In general the best physician is the one with whom a woman has the closest relationship; very often that's her gynecologist. But it could also be her family physician or her internist. Here are some of the most common terms menopausal women need to learn:

  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Vulvovaginal atrophy
  • Lubrication
  • Libido
  • Incontinence
  • Erectile dysfunction
  • Anorgasia (inability to achieve orgasm)

SC: In my opinion, the best type of physician is one trained in sexual health and human sexuality. They're more likely to be prepared to answer questions women have around different stages of their sexual life span. An integrated team can include gynecologists, sex therapists, naturopaths and pelvic floor physical therapists. As a woman ages, her pelvic floor tone naturally decreases and can reduce the intensity of orgasms and arousal. Kegel exercises can strengthen the pelvic floor and increase blood flow to the genital tissue to enhance orgasms.

You might also want to read:
Women and Libido at Midlife
Sex and a Healthier You Articles
What's REALLY Causing Your Low Sex Drive?


The upside of post-menopausal sex is that usually the kids have left home as well. Freedom is a pretty powerful motivator!

Great information for those of us who are post-menopausal. Thanks, Sheryl!

I find it so interesting that sex is the subject of so many posts these days. I guess I just never had an issue with knowing my body, where I was at and how to find answers. Apparently, there is a void out there and it needs to be filled, so thanksfor doing that!

You are very welcome, Carol. You sound like you're super tuned in to your body and its changes.

Thank your for bring this topic to the light and helping us women have frank discussions about sex and how it affects us as we age.

Hmmm... Interesting to read this. I have had hot flashes, which luckily are over now, but none of the rest. Thanks for the info.

Lucky you, Wendy! Consider yourself in the minority.

Great information here. It's reassuring to know we don't have to end up all dried up and asexual!

Yes, Lois, dried up doesn't sound the least bit tempting...

Wow Sheryl, I like to think I keep up on most things menopause but I learned a lot from this piece! Great information! Thank you so much for sharing!

So happy I could shed light on something new to you, Ruth!

Great info. Thanks for this very in-depth piece!

You are very welcome, Brette..glad you found it helpful.

I agree with Kim. This detail is often overlooked.

Indeed, it is overlooked. It's good that someone is willing to start the conversation!

Funny how now that the kids are gone and couples have so much more freedom to do whatever wherever they please, these internal roadblocks arise. You just can't win. Nice to hear that there is help, Sheryl.

That's true, Mindy...go figure.

Great information here, Sheryl. And, as always, there is comfort in knowing that we are not alone!

Glad you found it helpful, Helene!

Sex butter? Sounds interesting.

Thanks for the great info -- and happy birthday.

Thanks for the (early) birthday wishes, Ruth! Never heard of sex butter until now...salted butter, unsalted butter...but never that kind.178

What are the options for women who've had a TIA? My physician won't prescribe Osphena or premarin cream for me because of that, and sex is very painful, no matter what sort of lubrication we use. I'm 46, and had to have a hysterectomy at age 40. I feel frustrated and depressed--is my sex life over?

Great post. Thanks for all honest facts and practical solutions to issues women often don't want to talk about.

I am 60 and very active or was until a couple months ago. I started taking Osphena in May 2015. Started getting pain in my butt and legs quickly after starting the drug. I thought it was due to my job (very heavy and non stop), In September the pain was increasing. Saw the Ortho to check my hips. (hip replaced in 2013) He advised me the hips were fine. The pain was like bilateral Sciatica, it was worse in the morning and better during the day. It moved from side to side and up and down my legs, thighs and butt with NO back pain. It has become debilitating in the last month. Had to stop working, pulled out the crutches, went to the Chiropractor and have been suffering trying to find the answer. Went to family doc today. I stopped taking Osphena on Saturday thinking just maybe the cause of the pain. Doctor said very possible that it is causing the pain, pharmasist agrees and the Chiropractor. Was told it could take 2 weeks to tell if the Osphena was the cause of the debilitating leg/muscle pain. I will update as soon as I know. Jen


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